Perioperative anticoagulation in head and neck free flap reconstructions: Experience of an anticoagulative scheme and its modification

Abstract

ObjectivesMicrovascular anastomoses in microvascular reconstructions induce rheological changes in the anastomosed vessels and are usually counteracted by anticoagulative medication. There is no regimen commonly agreed on. This study provides an easy to use anticoagulative regimen.Patients and MethodsConsecutive cases of either anticoagulative regimen between 2013 and 2018 that underwent microvascular reconstruction in the head and neck area were included in this retrospective study, resulting in 400 cases in total. Two different anticoagulative regimens were applied to 200 patients in each group: (a) intraoperatively administered unfractionated 5000 I.U. high molecular weight heparin (HMWH) and postoperatively low molecular weight heparin (LMWH, Enoxaparin) 1 mg/kg/body weight postoperatively and (b) intraoperatively LMWH 0.5 mg/kg/body weight as well as 12 h later and 1 mg/kg/body weight postoperatively.ResultsThe LMWH cohort showed fewer overall thromboembolic (8.5% vs. 11%; p = .40) and peripheral thrombotic events (1% vs. 3.5%; p = .18) and lung embolisms (3% vs. 4%; p = .59). The number of thromboses at the site of the anastomosis was equally distributed. In regard to flap‐specific complications, LMWH was associated with a positive effect, in particular with respect to total flap losses (5% vs. 7%; p = .40) and wound‐healing disorders (14.5% vs. 20%; p = .145).ConclusionFindings indicate that intra‐ and postoperatively administered LMWH as the only anticoagulative medication seems reliable in our clinical routine of head and neck free flap reconstructions.

Clinical effectiveness of postoperative prostaglandin E1 administration in reducing flap necrosis following microsurgical reconstruction

“…Numerous prior studies have examined the efficacy of perioperative use of antithrombotic and/or antiplatelet agents in free flap surgery (Ashjian et al, 2007; Conrad & Adams Jr., 2001; Demir et al, 2016; Grill et al, 2023; Senchenkov et al, 2015). One major challenge in these studies has been the presence of selection bias, as the decision to use such medications or not could be often influenced by factors related to the surgeon or other variables, which could act as potentially significant confounders.…”